Case Studies in

Wound Care

Mary Farren, RN, MSN, CWOCN Centers of Excellence

Keys to Success

• Collaboration

• Technology

• Evidence-Based Protocols

Wound Management

• Goals of care: – Healing – Palliation

• Co-morbidities• Infection• Pain management • Laboratory data: Hgb, Hct, Albumin• Home care services: SN, PT, OT, SW,

HHA• Learning potential of the patient &

family

Pressure Ulcer:Nursing Care Components

• Address all risk factors

• Secure needed support surfaces

• Evaluate rehabilitation needs

• Provide family support and education

Home Management of a Pressure Ulcer

• Home Visit by MD • Wound debridement

in the home• Curasalt Hypertonic

Saline Dressing QD • Group 2 Support

surface• Interdisciplinary

collaboration

7/26

Home Management of a Pressure Ulcer

• Post debridement

• Treatment & dressings modified over time

• Family education was successful

8/16

Successful Achievement of Outcomes

• Appropriate support service

• Effective wound treatment

• Healing in 7 weeks

9/13

Technology in the Home:Surgical Wound

• Vacuum assisted closure

• Wound measurement: 12.5 x 5.5 x 4cm

• Mesh exposed, sutures visible

5/13

Successful Achievement of Outcomes

• Effective wound treatment

• Ostomy management

• Healing in 6 weeks.

6/23

Home Management of aSurgical Wound

• Clinical specialist consultation

• Exposed tendon

• Treatments modified over time

– silver impregnated hydrogel

4/28

Successful Achievement of Outcomes

• Diabetes adherence addressed

• Healing in 14 weeks

8/04

Criteria for VNSNY Clinical Specialist Consultation

• Stage three, four, or unstageable pressure ulcer

• Wound worsening under care

• Unconventional treatment

• Assistance needed with palliative care options

• RN/MD collaboration for evidenced based treatment

• Nurse requests support for complex care management issues

• Request for VAC therapy

Interdisciplinary Communication

and Collaboration• Collaboration

• Improved patient outcomes

• Avoidance of hospitalization

• Improved compliance with regulatory requirements